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Ophthalmology Flashcards

1
Q

What is glaucoma?

A

Optic nerve damage from rise in intraocular pressure

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2
Q

Glaucoma pathophysiology?

A
  • Imbalance in aqueous humour production / drainage - usually blockage
  • normal pressure 10-21 mmHg
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3
Q

What is the pathophysiology of open angle glaucoma?

A

a gradual increase in resistance within the trabecular network results in increased IOP and damage to optic nerve

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4
Q

open angle glaucoma RF?

A
  • increased age
  • myopia (near sighted)
  • FHx
  • black ethnic background
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5
Q

Open angle glaucoma Px?

A

typically asymptomatic

if symptomatic:
- tunnel vision
- halos around lights
- pain
- headaches

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6
Q

Open angle glaucoma screening

A
  • strong FHx - every 2yrs from 30yo
  • every 5yrs >40yo, every 2yrs >60
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7
Q

Open angle glaucoma Ix ?

A
  1. visual fields - tunnel vision
  2. fundoscopy / slit lamp - cupping of optic disc
  3. Goldmann applanation tonometry - checks intraocular pressure

NB can use non-contact tonometry
- puff of air, estimate IOP (raised)

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8
Q

Open angle glaucoma Mx?

A

Start when IOP >24 mmHg:

  1. 360-degree selective laser trabeculoplasty - involves directing a laser at trabecular network to try and improve drainage

1st line medical Tx:
- prostaglandin analogue eye drops e.g latanoprost

other topical options?
- beta blockers e.g. timolol
- carbonic anhydrase inhibitor e.g. acetazolamide
- alpha 2 agonists e.g. brimonidine

surgical option?
- trabeculectomy

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9
Q

What is acute angle closure glaucoma?

A
  • complete closure of angle between the iris and cornea (e.g. due to iris bulging forward) which prevents drainage of the aqueous fluid leading to IOP and optic nerve damage

ophthalmic emergency!!!

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10
Q

Risk factors for acute angle closure glaucoma?

A
  • Increasing age
  • Family history
  • Female (four times more likely than males)
  • Chinese and East Asian ethnic origin
  • Shallow anterior chamber
  • hyperopia

contributory medications? TCAs, adrenergic meds and anticholinergic meds

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11
Q

AACG Px

A
  • red, painful eye
  • N+V
  • headache
  • halo around lights
  • sx worse with pupil dilatation - eg will be watching TV in dark room
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12
Q

AACG examination findings?

A
  • pupil sluggish + dilated
  • eye hard to palpation
  • reduced visual acuity
  • hazy cornea (oedema)
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13
Q

AACG Ix

A
  • tonometry - IOP >60
  • gonioscopy - look at angle (lens on slit lamp)
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14
Q

AACG Mx

A
  • lie on back w/o pillow, urgent ophthal referral
  • Pilocarpine eye drops (2% for blue and 4% for brown eyes) = acts on muscarinic receptors around iris to prompt pupil constriction + ciliary muscle constriction to try and open up path for aqueous humour flow
  • Acetazolamide 500 mg orally = reduces aqueous humour production
  • analgesia +/- antiemetics

definitive treatment = laser iridotomy - both eyes

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15
Q

what is age related macular degeneration? what are the two types of ARMD?

A

damage to the macula with central vision loss
- most common cause of blindness in
UK

  1. Wet (also called neovascular), accounting for 10% of cases
  2. Dry (also called non-neovascular), accounting for 90% of cases
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16
Q

ARMD - risk factors?

A

Older age
Smoking
Family history
Cardiovascular disease (e.g., hypertension)
Obesity
Poor diet (low in vitamins and high in fat)

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17
Q

ARMD pathophysiology?

A
  • Degeneration of retinal photoreceptors
  • formation of drusen (protein and lipid deposits)
  • atrophy of retinal pigment epithelium

Dry / atrophic - 90% - early
Drusen, changes in pigmentation of retinal pigment endothelium

Wet / exudative - 10% - late
choroidal neovascularisation, VEGF, oedema, rapid vision loss

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18
Q

ARMD Px?

A
  • Gradual loss of central vision
  • Reduced visual acuity
  • Crooked or wavy appearance to straight lines (metamorphopsia)
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19
Q

ARMD Ix

A
  • visual acuity: reduced
  • fundoscopy: drusen, red patches in wet ARMD
  • Amsler grid testing - line appears crooked
  • Slit lamp - pigmentary/exudative/haemorrhagic changes
  • fluorescein angiography to see neovascularisation and leakage
  • optical coherence tomography (OCT) to confirm Dx and monitor
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20
Q

ARMD Mx

A

Urgent referral to ophthalmology

Dry ARMD?
- stop smoking, control BP
- zinc, vit A, C, E

Wet ARMD?
- intravitreal injection of Anti-VEGF

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21
Q

Diabetic retinopathy

A

Retinal deterioration from blood vessel damage due to high blood sugar levels

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22
Q

how do you classify diabetic retinopathy?

A

Proliferative – neovascularisation and vitreous haemorrhage

Non proliferative - micro aneurysms, retinal haemorrhages, hard exudates, blot haemorrhages

NB maculopathy exists separately and involves exudates in macula and macula oedema

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23
Q

Diabetic retinopathy Px

A

non proliferative? asymptomatic

proliferative? vitreous haemorrhage, floaters, blurred vision

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24
Q

Diabetic retinopathy Ix

A
  • visual acuity
  • fundoscopy
  • fluroscein angiography
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25
Q

Diabetic retinopathy Mx

A
  • optimise BMs, BP, lipids, healthy diet, stop smoking

maculopathy
- anti-VEGF

non-proliferative
- observation / panretinal laser photocoagulation

Proliferative
- panretinal laser photocoagulation
- anti-VEGF

Vitreous haemorrhage
- vitreoretinal surgery

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26
Q

What might you see on fundoscopy with diabetic retinopathy?

A

Blot haemorrhages
Hard exudates
Microaneurysms
Venous beading
Cotton wool spots
Intraretinal microvascular abnormalities
Neovascularisation

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27
Q

Complications of diabetic retinopathy?

A

Retinal detachment
Vitreous haemorrhage
Rebeosis iridis - new blood vessel formation in iris
Optic neuropathy
Cataracts

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28
Q

Hypertensive retinopathy

A

damage to small blood vessels in retina from systemic HTN

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29
Q

Hypertensive retinopathy Px

A
  • can be asym
  • double vision / blurred vision / reduced acuity / visual field defects
  • headaches
  • eye pain
  • N+V
  • end organ damage - HF, AKI, chest pain
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30
Q

Hypertensive retinopathy Ix

A
  • BP
  • fundoscopy
  • OCT / fluorescein angiography
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31
Q

What might you see on hypertensive retinopathy fundoscopy?

A
  • silver / copper wiring
  • AV nipping
  • cotton wool spots
  • hard exudates
  • retinal haemorrhages
  • papilloedema
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32
Q

Hypertensive retinopathy - Keith-Wagener classification

A

Stage 1: Mild narrowing of the arterioles
Stage 2: Focal constriction of blood vessels and AV nicking
Stage 3: Cotton-wool patches, exudates and haemorrhages
Stage 4: Papilloedema

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33
Q

Hypertensive retinopathy Mx

A
  • control BP
  • stop smoking
  • control lipids
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34
Q

What are cataracts? What are possible causes?

A

opacification of lens causing reduced visual acuity

Causes
smoking, alcohol, age, trauma, DM, long-term steroids, radiation, myotonic dystrophy, hypocalcaemia

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35
Q

Cataracts Px

A
  • gradual onset, asymmetrical
  • blurry vision
  • faded colour vision
  • starbursts around lights - at night
  • poor night vision
  • white/brown lens when light shone on eye
  • reduced red reflex
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36
Q

Cataracts Ix

A
  • ophthalmoscopy - normal fundus / optic nerve
  • slit lamp
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37
Q

Cataracts Mx

A
  • surgery
  • stronger glasses, brighter lights in meantime
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38
Q

key examination finding in cataracts?

A

loss of red reflex
lens may appear grey / white

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39
Q

name 1 rare but serious complication of cataract surgery?

A

Endophthalmitis: inflammation of the inner contents of the eye (usually due to infection)

Tx with intravitreal antibiotics injected directly into eye

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40
Q

Blepharitis - causes, Px and Mx

A
  • inflammation of eyelid margins

Causes
- meibomian gland dysfunction - lack of oil, drying of eyes
- seborrhoeic dermatitis / staph infection

Px
- bilateral
- gritty, sticky eyes
- red eyelid margins
- swollen - staph

Mx
- hot compress
- lid hygiene - cotton wool buds, warm water, baby shampoo
- artificial tears - dry eyes

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41
Q

Stye - types, Px and Mx

A
  • painful red lump on eyelid edge
  • infection and inflammation of tear glands

Types
External - infection of glands of zeis / moll
Internal - infection of meibomian glands

Px
external - tender red lump along eyelid +/- pus
internal - deeper, more painful, may point inwards

Mx
- hot compress
- analgesia
- topical abx if conjunctivitis

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42
Q

Chalazion - Px and Mx

A
  • obstruction of sebaceous gland causing gland to enlarge
  • it can rupture, prompting inflammatory response

Px
- swelling in eyelid
- may be painless / tender
- red

Mx
- hot compress
- analgesia
- topical abx if inflamed
- surgical drainage if the above fails

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43
Q

Entropion

A
  • eyelid turns in

Mx
- tape eyelid down, eye drops to prevent eye drying
- surgery - definitive
- same day ophthal referral if risk to sight

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44
Q

Ectropion

A
  • eyelid turns out, usually bottom

Mx
- mild - no tx
- eye drops
- surgery
- same day ophthal referral if risk to sight

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45
Q

Trichiasis : Px and Mx

A
  • inward growth of eyelash

Px
- painful
- red, watery eye
- feels like FB in eye

Mx
- remove eyelash
- electrolysis, cryotherapy, laser tx if recurrent growth
- same day referral if risk to sight

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46
Q

What might cause an abnormal pupil shape?

A
  • trauma, eg cataracts surgery
  • anterior uveitis - adhesions
  • AACG - vertical oval shape
  • rubeosis iridis - neovascularisation of iris
  • coloboma - congenital malformation
  • tadpole pupil - spasm in iris - migraines
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47
Q

what might cause mydriasis (dilated pupil)

A
  • 3rd nerve palsy
  • Homes-Adie syndrome
  • raised ICP
  • congenital
  • trauma
  • phaeochromocytoma
  • drugs - atropine, cocaine, amphetamines, TCAs
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48
Q

what might cause miosis (constricted pupil)

A
  • Horner syndrome
  • cluster headaches
  • Argyll-Robertson pupil
  • opiates
  • nicotine
  • pilocarpine
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49
Q

3rd nerve palsy - Px and possible causes ?

A
  • ptosis
  • dilated pupil
  • divergent strabismus - down + out eye

Causes
- idiopathic
With sparing of pupil (microvascular - psym fibres spared):
- DM, HTN, ischaemia
Full palsy - compression
- tumour, trauma, cavernous sinus thrombosis, PCA aneurysm, raised ICP

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50
Q

CN4 palsy Px

A

eye ‘up and out’ when looking forward

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51
Q

CN6 palsy Px

A

right eye turns ‘in’ on looking forward

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52
Q

innervation of ocular muscles

A

LN6(SO4)3 - mnemonic

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53
Q

What is Horner’s?

A
  • damage to sympathetic nerves system supplying face
  • sympathetic nerves arise from spinal cord in chest (preganglionic nerves)
  • enter sympathetic ganglion inneck and exist as post ganglionic nerves
  • post ganglionic nerves travel to head alongside internal carotid

Ix
- Cocaine eye drops? - cause dilatation in normal eye, not in Horner’s
- adrenaline eye drops - as above

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54
Q

locating Horner’s?

A

Determined by the anhidrosis (loss of sweating)

  • Central lesions (occurring before the nerves exit the spinal cord) cause anhidrosis of the arm, trunk and face
  • Pre-ganglionic lesions cause anhidrosis of the face. - - Post-ganglionic lesions do not cause anhidrosis.
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55
Q

what is the Horner’s syndrome triad?

A
  • ptosis
  • miosis
  • anhidrosis
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56
Q

causes of Horner’s? central, preganglionic and post ganglionic

A

Central lesions - anhidrosis of arm, trunk, face (4 Ss)
- Stroke
- MS
- Swelling (tumours)
- Syringomyelia
- also encephalitis

Pre-ganglionic lesions - anhidrosis of face (4 Ts)
- Tumour - eg Pancoast
- Trauma
- Thyroidectomy
- Top rib - cervical rib

Post-ganglionic lesions - no anhidrosis (4 Cs)
- Carotid aneurysm
- Carotid artery dissection
- Cavernous sinus thrombosis
- Cluster headache

57
Q

Holmes Adie pupil

A
  • caused by damage to the post-ganglionic parasympathetic fibres

pupil is:
- Dilated
- Sluggish to react to light
- Responsive to accommodation (the pupils constrict well when focusing on a near object)
- Slow to dilate following constriction (“tonic” pupil)

Holmes-Adie syndrome = Holmes Adie pupil + absent ankle / knee reflexes

58
Q

Argylle Robertson Pupil

A
  • specific finding in neuro syphilis
  • constricted pupil that accommodates when focusing on a near object but does not react to light
59
Q

Conjunctivitis

A

inflammation of conjunctiva - layer of tissue on inside of eyelids / sclera

bacterial / viral / allergic

60
Q

Conjunctivitis Px - include differences between viral and bacterial

A
  • uni/bilateral
  • red eye
  • bloodshot
  • itchy / gritty
  • discharge
  • NO pain, photophobia, reduced acuity
61
Q

signs of bacterial conjunctivitis?

A
  • purulent discharge, worse in morning (eyes stuck together)
  • can start unilateral, then spread
  • highly contagious
62
Q

signs of viral conjunctivitis?

A
  • clear discharge, other viral sx, lymph nodes,
  • highly contagious
63
Q

Painless red eye DDx

A

Painless
- conjunctivitis
- episcleritis
- subconjunctival haemorrhage

64
Q

Painful red eye DDx

A

Painful
- glaucoma
- anterior uveitis
- scleritis
- corneal abrasions / ulceration
- keratitis
- FB
- trauma / chemical injury

65
Q

Conjunctivitis Mx

A
  • usually resolves alone 1-2 wks
  • wash hands, don’t share towels, clean ey
  • bacterial - abx eye drops - chloramphenicol / fusidic acid topical (pregnancy)
  • no contact lenses, topical fluorescein to identify corneal staining
  • neonate <1mo - urgent ophthal review - ?gonococcal infection -> loss of sight, pneumonia
66
Q

Allergic conjunctivitis

A
  • contact with allergens

Px
- bilateral
- swelling
- watery discharge
- itch
- Hx of atopy
- seasonal / perennial

Mx
- antihistamines - topical / oral
- topical mast-cell stabilisers - for chronic sx

67
Q

Anterior uveitis

A

Inflammation of anterior part of uvea - iris, ciliary body, choroid

68
Q

what conditions is anterior uveitis associated with?

A
  • Seronegative spondyloarthropathies (e.g., ankylosing spondylitis, psoriatic arthritis and reactive arthritis)
  • Inflammatory bowel disease
  • Sarcoidosis
  • Behçet’s disease
  • HLA-B27
69
Q

Anterior uveitis Px

A
  • Painful red eye (typically a dull, aching pain)
  • Reduced visual acuity
  • Photophobia (due to ciliary muscle spasm)
  • Excessive lacrimation (tear production)
70
Q

Anterior uvetitis Ix? what might you see on examination?

A
  • slit lamp

examination findings?
1. Ciliary flush (a ring of red spreading from the cornea outwards)
2. Miosis (a constricted pupil due to sphincter muscle contraction)
3. Abnormally shaped pupil due to posterior synechiae (adhesions) pulling the iris into abnormal shapes
4. Hypopyon (inflammatory cells collected as a white fluid in the anterior chamber)

71
Q

Anterior uveitis Mx

A
  • same day ophthal assessment
    1. steroids - oral / topical / IV
    2. cyclopentolate / atropine eye drops - cycloplegic (paralyse ciliary muscles) + mydriatic (dilate pupil)

recurrent cases?
- immunosuppressants - DMARDs, TNF inhibitor

72
Q

Episcleritis

A
  • benign self-limiting inflammation of episclera (just beneath conjunctiva)
  • RA / IBD association, not usually infection
73
Q

Episcleritis Px

A
  • acute, unilateral
  • painless / mild pain
  • red eye - red patch
  • FB sensation
  • dilated episcleral vessels
74
Q

Episcleritis Ix

A
  • apply phenylephrine drops - it will cause blanching of episcleral vessels causing redness to disappear
  • this won’t happen for scleral vessels so doesn’t impact redness in scleritis
75
Q

Episcleritis Mx

A
  • self-limiting - 1-4wks
  • lubricating eye drops for sx
  • analgesia, cold compress
  • severe - NSAIDs, steroid eye drops
76
Q

what is scleritis?

A
  • inflammation of sclera
  • most cases idiopathic or associated with underlying systemic inflammatory conditions
  • if necrotising - can perforate sclera

sclera = outer layer of connective tissue surrounding most of the eye

77
Q

systemic conditions associated with scleritis?

A
  • Rheumatoid arthritis
  • Vasculitis, particularly granulomatosis with polyangiitis)
78
Q

Scleritis Px

A
  • red eye
  • painful
  • watering
  • photophobia
  • gradual reduction in vision
  • abnormal pupil reaction to light
  • eye tender to palpation
79
Q

Scleritis Mx

A
  • same day ophthal referral
  • NSAIDs - oral / topical - 1st line
  • Steroids - oral / topical - more severe
  • immunosuppressants - resistant cases
80
Q

What is a corneal abrasion?

A
  • scratches / damage to corneal epithelium
81
Q

what can cause corneal abrasions?

A
  • Contact lenses (beware pseudomonas)
  • foreign body
  • fingernails, eyelashes, entropion
  • chemical - acid
82
Q

Corneal abrasion Px

A
  • hx of FB / contact lens
  • painful red eye
  • foreign body sensation
  • watery eye
  • blurred vision
  • photophobia
83
Q

Corneal abrasion Ix

A
  • fluorescein stain - yellow / orange in abrasion/ulcer
  • slit lamp
84
Q

Corneal abrasion Mx

A
  • if ?sight-threatening - ophthal referral
  • remove FB
  • analgesia
  • lubricating eye drops
  • abx - chloramphenicol eye drops
  • consider cyclopentolate eye drops - dilate pupil - may help sx
  • 24hr follow up, heal in 2-3d
  • chemical - 20-30min irrigation, urgent ophthal referral
85
Q

corneal foreign body red flags?

A
  • severe pain
  • irregular / non-reactive pupils
  • reduced visual acuity
86
Q

What is keratitis?

A

Inflammation of cornea - potentially sight-threatening

87
Q

Keratitis causes

A
  • Viral - herpes simplex
  • Bacteria - pseudomonas / staph
  • Fungal - candida / aspergillus
  • Amoebic - acanthamoebic keratitis - eg contaminated water - pain out of proportion to findings
  • Parasitic - onchocercal keratitis - river blindness
  • Contact lens acute red eye (CLARE)
  • Exposure keratitis - from inadequate eyelid coverage (eg ectropion)
88
Q

Corneal ulcers : RFx, Px, Ix and Mx

A
  • defect in cornea, 2ndary to infection (eg abrasion from trauma)

RFs
- contact lenses
- vit A deficiency

Px
- eye pain, photophobia, watering of eye

Ix
- fluorescein stain - focal stain

Mx
- if contact lenses - same day ophthal referral - slit lamp to r/o microbial keratitis
- topical abx - quinolones
- cyclopentolate - pain relief

89
Q

Herpes simplex keratitis: Ix?

A

Ix
- fluorescein - dendritic corneal ulcer
- slit lamp
- corneal swabs / scrapings - PCR / viral culture

90
Q

most common cause of keratitis?

A

herpes simplex keratitis

91
Q

Px of herpes simplex keratitis?

A
  • painful red eye
  • photophobia
  • vesicles around eye
  • FB sensation, watering eye
  • reduced acuity
92
Q

Mx of herpes simplex keratitis?

A
  • refer to ophthalmologist
  • topical / oral antiviral (acyclovir or ganciclovir)
  • if corneal scarring - corneal transplant
93
Q

Subconjunctival haemorrhage

A
  • rupture + bleeding of small vessels in conjunctiva - bleed in between sclera + conjunctiva
94
Q

Causes of subconjunctival haemorrhage

A
  • trauma
  • heavy lifting / coughing
  • straining, eg constipated
  • HTN, bleeding disorders, whooping cough, blood thinners, NAI
95
Q

Subconjunctival haemorrhage Px

A
  • patch of bright red blood
  • painless
  • no vision loss
96
Q

Subconjunctival haemorrhage Mx

A
  • resolve spontaneously in 2wks
  • Ix for ?underlying condition
  • lubricating eye drops - if FB sensation
97
Q

Posterior vitreous detachment & RFx

A

detachment of vitreous gel from retina

RFs
- older
- myopic (near sighted - longer axial length)

98
Q

Posterior vitreous detachment Px

A
  • ?asym
  • painless
  • spots of vision loss
  • floaters
  • flashing lights
99
Q

Posterior vitreous detachment Ix

A
  • same day ophthal assessment - r/o retinal detachment
  • ophthalmoscopy - Weiss ring - ring-shaped floater around optic nerve
100
Q

Posterior vitreous detachment Mx

A

no tx - brain adjusts

101
Q

what happens in retinal detachment

A
  • retina separates from underlying pigment epithelium / choroid
  • choroid supplies blood to retina -> detachment is sight-threatening
  • usually due to retinal tear - then vitreous fluid gets under retina
102
Q

retinal detachment RFx

A

Posterior vitreous detachment
Trauma
Diabetic retinopathy
Retinal malignancy
Family history
myopia

103
Q

Retinal detachment Px

A
  • painless
  • peripheral vision loss - sudden, like shadow
  • blurred / distorted vision
  • flashes / floaters
104
Q

Retinal detachment Ix

A
  • same day ophthal assessment
  • fundoscopy - loss of red reflex, pale/opaque/wrinkled retinal folds
  • slit lamp, indirect ophthalmoscopy
105
Q

Retinal detachment Mx

A

Retinal tears - create adhesions between retina / choroid
- laser therapy
- cryotherapy

Retinal detachment - reattach retina
- vitrectomy
- scleral buckling - squashes eye to try and force reattachment
- pneumatic retinoplexy: uses gas bubble to hold detached layer in place

106
Q

Retinitis pigmentosa

A

genetic condition causing degeneration of the photoreceptors in the retina (rods mostly affects, cones affected later)

107
Q

Retinitis pigmentosa Px

A
  • most cases, sx start in childhood

rods degenerate first so:
- night blindness
- tunnel vision / loss of peripheral vision

108
Q

Retinitis pigmentosa Ix

A
  • fundoscopy - bone-spicule pigmentation, arteriole narrowing, waxy/pale optic disc
109
Q

Retinitis pigmentosa Mx

A

no cure - focus on improving function

  • genetic counselling
  • vision aids
  • sunglasses
  • inform DVLA

future treatment options? gene therapy

110
Q

Central retinal vein occlusion

A

thrombus forms in retinal vein, blocks blood drainage from retina

111
Q

CRVO pathophysiology and RFx

A
  • can be blockage in 1/4 branches, or blockage in central vein (whole retina affected)
  • blood pools and fluid leaks leading to macula oedema and retinal haemorrhages
  • retinal ischaemia leads to VEGF release and neovascularisation

RFs
- HTN, high cholesterol, DM, smoking, glaucoma, SLE

112
Q

CRVO Px

A
  • sudden painless loss of vision, unilateral usually
113
Q

CRVO Ix (and findings)

A
  • fundoscopy: flame + blot haemorrhages, optic disc oedema, macula oedema
  • FBC, ESR, BP, BMs
114
Q

CRVO Mx

A
  1. refer to ophthalmologist

Mx focused on treating macula oedema and preventing neovascularisation:
- Anti-VEGF therapies (e.g., ranibizumab and aflibercept)
- Dexamethasone intravitreal implant (to treat macular oedema)
- Laser photocoagulation (to treat new vessels)

115
Q

Central retinal artery occlusion

A

blockage of central retinal artery

116
Q

CRAO pathophysiology and possible causes

A
  • blockage of central retinal artery - a branch of ophthalmic artery which is a branch of internal carotid

Causes
- most common = atherosclerosis - RFx include smoking, HTN, DM, high cholesterol
- GCA - RFx include >50yo, F>M, PMR

117
Q

CRAO Px

A
  • sudden painless loss of vision
  • RAPD
118
Q

CRAO

A
  • fundoscopy - pale retina, cherry-red spot macula
  • ESR, temporal artery biopsy
119
Q

CRAO Mx

A
  1. emergency ophthalmology referral
  2. address reversible causes e.g. GCA (prednisolone 60mg)
  3. ? ocular massage or anterior chamber paracentesis to try and dislodge clot ? GTN to dilate vessels
  4. long term - treat cardiovascular RFx
120
Q

what is a vitreous haemorrhage? what can cause it?

A
  • bleeding into vitreous humour

causes
- proliferative diabetic retinopathy
- posterior vit detachment
- retinal detachment
- ocular trauma

121
Q

Vitreous haemorrhage Px

A
  • acute, painless visual loss / haze
  • red hue in vision
  • floaters
122
Q

Vitreous haemorrhage Ix

A
  • acuity: decreased
  • fundoscopy: haemorrhage in vitreous gel
123
Q

Vitreous haemorrhage Mx

A
  1. refer to ophthalmologist to r/o retinal detachment

no retinal detachment? blood should clear on its own
retinal detachment? vitrectomy

124
Q

Sudden loss of vision DDx

A
  • retinal detachment
  • central retinal artery occlusion
  • central retinal vein occlusion
  • vitreous haemorrhage (due to diabetic retinopathy)

NB amaurosis fugax = temporary loss of vision causes by temporary interruption to blood supply

125
Q

Blurred vision - causes, Ix and Mx

A
  • loss of clarity of vision

Causes
- refractive error
- cataracts
- retinal detachment
- ARMD, AACG, optic neuritis, amaurosis fugax

Ix
- snellen chart
- visual fields
- fundoscopy

Mx
- opticians if refractive
- ophthal referral if other sx

126
Q

Herpes zoster ophthalmicus (HZO) - Px, Mx and Cx

A
  • reactivation of VZV in ophthalmic division of trigeminal nerve = shingles of the eye

Px
- vesicular rash around eye +/- eye
- hutchinson’s sign - rash on tip / side of nose

Mx
- oral antivirals
- topical corticosteroids
- ophthal review if eye involvement

Cx
- conjunctivitis, keratitis, episcleritis, anterior uveitis, ptosis, post-herpetic neuralgia

127
Q

Nasolacrimal duct obstruction

A
  • imperforate membrane at lower end of duct -> persist watery eye in infant

Mx
- parents massage lacrimal duct
- in 95% sx resolve by 1yo
- ophthal referral for ?probing

128
Q

Hyphema

A
  • blood in anterior chamber of eye
  • raised IOP - sight-threatening, block IC angle, trabecular meshwork
  • urgent ophthal referral
  • admit, bed rest
129
Q

Optic neuritis definition and causes

A

inflammation of optic nerve (often demyelination) -> loss of vision

Causes
MS, diabetes, syphilis, ischaemic optic neuropathy

130
Q

Optic neuritis Px

A
  • blurred vision
  • reduced colour vision
  • eye pain at rest and on movement
131
Q

Optic neuritis Ix

A

CN exam: RAPD, reduced colour vision and visual field loss

Fundoscopy: often normal but may see swollen optic nerve

MRI: may show evidence of MS

132
Q

Optic neuritis Mx

A
  • high dose methylprednisolone
133
Q

Papilloedema: definition and causes?

A
  • optic disc swelling caused by raised ICP
  • almost always bilateral

Causes
- SOL, malignant HTN, IIH, hydrocephalus, hypercapnia, hypoparathyroidism, hypocalcaemia, vit A toxicity

134
Q

Papilloedema fundoscopy findings

A
  • venous engorgement
  • loss of venous pulsation
  • blurring of optic disc margin
  • elevation of optic disc
  • loss of optic cup
  • Paton’s lines
135
Q

RAPD - definition and causes

A
  • relative afferent pupillary defect / Marcus-Gunn pupil
  • lesion is anterior to optic chiasm - optic nerve / retina

Causes
- retina - detachment
- optic nerve - neuritis, eg MS

136
Q

RAPD examination findings

A
  • swinging light test - affected eye dilates when light shone on it, constricts when light shone on normal eye
137
Q

Causes of tunnel vision

A
  • papilloedema
  • glaucoma
  • retinitis pigmentosa
  • choroidoretinitis
  • optic atrophy after tabes dorsalis
  • hysteria
138
Q

periorbital / pre septal cellulitis? defintion, Px, Mx

A
  • eyelid and skin infection in front of the orbital septum (in front of the eye)
  • presents with swollen red hot skin around eye/eyelid
  • Mx with systemic antibiotics
139
Q

orbital cellulitis?

A
  • infection around the eyeball involving the tissues behind the orbital septum.

Px
- pain with eye movement
- reduced eye movements
- vision changes
- abnormal pupil reactions
- proptosis (bulging forward of the eyeball)

Mx
- emergency admission + IV antibiotics
- may need surgery if abscess seen on CT

finals (23 decks)

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